Diagnostic accuracy of direct ophthalmoscopy for detection of diabetic retinopathy using fundus photographs as a reference standard

Ahsan, Shahid; Basit, Abdul; Ahmed, Kazi Rumana; Ali, Liaquat; Shaheen, Fariha; Ulhaque, Muhammad Saif; Fawwad, Asher

doi:10.1016/j.dsx.2014.04.015

Cited by 11 publications

(7 citation statements)

References 25 publications

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“…In this study, a lower rate of ungradable images was reported (56/1511, 4.1%) than that reported in similar health facility-based studies in the South Asian context. A technical failure rate of 7.5% was noted in another study in Bangladesh [35], which rose to 12% in Sri Lanka [10]. The higher level of gradeability observed in our study is probably a function of the exclusion criteria or the image-taking technique that was employed.…”

Section: Discussioncontrasting

confidence: 46%

“…Strong agreement was noted between the diabetic retinopathy classification of registered nurses and paramedics and that of the gold standard diagnosis by eye consultants, with kappa values of 0.70 and 0.85, respectively, whereas nonclinical trained staff had weak agreement (κ=0. 35). As shown in Table 3, non-ophthalmologists were particularly good at detecting the presence or absence of diabetic retinopathy.…”

Section: Diabetic Retinopathy Accuracy Test Resultsmentioning

confidence: 92%

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Diagnostic Accuracy of Detecting Diabetic Retinopathy by Using Digital Fundus Photographs in the Peripheral Health Facilities of Bangladesh: Validation Study

Begum

Rahman

Nomani

et al. 2021

JMIR Public Health Surveill

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Background Diabetic retinopathy can cause blindness even in the absence of symptoms. Although routine eye screening remains the mainstay of diabetic retinopathy treatment and it can prevent 95% of blindness, this screening is not available in many low- and middle-income countries even though these countries contribute to 75% of the global diabetic retinopathy burden. Objective The aim of this study was to assess the diagnostic accuracy of diabetic retinopathy screening done by non-ophthalmologists using 2 different digital fundus cameras and to assess the risk factors for the occurrence of diabetic retinopathy. Methods This validation study was conducted in 6 peripheral health facilities in Bangladesh from July 2017 to June 2018. A double-blinded diagnostic approach was used to test the accuracy of the diabetic retinopathy screening done by non-ophthalmologists against the gold standard diagnosis by ophthalmology-trained eye consultants. Retinal images were taken by using either a desk-based camera or a hand-held camera following pupil dilatation. Test accuracy was assessed using measures of sensitivity, specificity, and positive and negative predictive values. Overall agreement with the gold standard test was reported using the Cohen kappa statistic (κ) and area under the receiver operating curve (AUROC). Risk factors for diabetic retinopathy occurrence were assessed using binary logistic regression. Results In 1455 patients with diabetes, the overall sensitivity to detect any form of diabetic retinopathy by non-ophthalmologists was 86.6% (483/558, 95% CI 83.5%-89.3%) and the specificity was 78.6% (705/897, 95% CI 75.8%-81.2%). The accuracy of the correct classification was excellent with a desk-based camera (AUROC 0.901, 95% CI 0.88-0.92) and fair with a hand-held camera (AUROC 0.710, 95% CI 0.67-0.74). Out of the 3 non-ophthalmologist categories, registered nurses and paramedics had strong agreement with kappa values of 0.70 and 0.85 in the diabetic retinopathy assessment, respectively, whereas the nonclinical trained staff had weak agreement (κ=0.35). The odds of having retinopathy increased with the duration of diabetes measured in 5-year intervals (P<.001); the odds of having retinopathy in patients with diabetes for 5-10 years (odds ratio [OR] 1.81, 95% CI 1.37-2.41) and more than 10 years (OR 3.88, 95% CI 2.91-5.15) were greater than that in patients with diabetes for less than 5 years. Obesity was found to have a negative association (P=.04) with diabetic retinopathy. Conclusions Digital fundus photography is an effective screening tool with acceptable diagnostic accuracy. Our findings suggest that diabetic retinopathy screening can be accurately performed by health care personnel other than eye consultants. People with more than 5 years of diabetes should receive priority in any community-level retinopathy screening program. In a country like Bangladesh where no diabetic retinopathy screening services exist, the use of hand-held cameras can be considered as a cost-effective option for potential system-wide implementation.

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Section: Discussioncontrasting

confidence: 46%

Section: Diabetic Retinopathy Accuracy Test Resultsmentioning

confidence: 92%

Diagnostic Accuracy of Detecting Diabetic Retinopathy by Using Digital Fundus Photographs in the Peripheral Health Facilities of Bangladesh: Validation Study

Begum

Rahman

Nomani

et al. 2021

JMIR Public Health Surveill

View full text Add to dashboard Cite

show abstract

“…While the data from this study were within the range of sensitivities and specificities reported in a large meta-analysis of DR screening methods, 31 one reason for the lower positive predictive value might be that in the current study, the clinical examination was considered the gold standard. It is possible that ophthalmoscopy may not be the best way to detect DR. [32][33][34][35][36][37][38] There are several limitations of the study based on the nature of the retrospective review. Because this was a retrospective study, there was no possibility to contact patients that were screened and encourage them to return for follow-up.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Evaluation of a Teleretinal Screening Program in Detecting Multiple Nondiabetic Eye Diseases

Maa

Patel

Chasan

et al. 2017

Telemedicine and e-Health

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“…Direct ophthalmoscopy in the hands of well-trained optometrist might be a cheaper method. A study carried in a tertiary care diabetes center reported sensitivity of 60% and specificity of 76% 13 . The findings of this study though did not validate the use of direct ophthalmoscopy by Diabetologist; authors however advocated its use and suggested to invest on the training of health care providers till financial resources allow shifting to the modern technology like fundus camera.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Direct Ophthalmoscopy and Non-Mydriatic Retinal Photography by Trained Optometrists for Screening of Diabetic Retinopathy

Memon¹,

Ahsan²,

Fahadullah³

et al. 2020

pak J Ophthalmol

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Purpose: To determine the reliability of direct ophthalmoscopy and Non-Mydriatic fundus photography for screening of Diabetic Retinopathy by optometrist. Study Design: Observational, cross sectional. Place and Duration of Study: Al-Ibrahim eye hospital, Karachi from October to December 2018. Material and Methods: All individuals with type 2 diabetes of≥ 40 years of age were screened for diabetic retinopathy (DR) by two trained optometrists and an ophthalmologist. First Optometrist used Non Mydriatic Fundus Camera (NMFC) and second optometrist used direct ophthalmoscopy (DO) after dilating the pupils. Final examination was done by the Ophthalmologist with slit lamp using Volk fundus lens which was considered as reference standard. Every investigator was kept unaware of the findings of others. Results: A total of 698 eyes of 349 respondents were screened. Ophthalmologist could not make decision by bio microscopy in 44 (6.3%) individuals as compared to 128 (18.3%) by 1st optometrist by NMFC and 142 (20.3%) by 2nd optometrist with DO. Diabetic retinopathy (DR) was diagnosed in 1493 (21.4%) with slit lamp, in 1172 (16.8%) with NMFC and in 1333 (19.1%) with DO. Sensitivity of NMFC was 76% and that of DO was 64.8%. Specificity of NMFC was 97.45% and that of DO was 96.63%. Positive predictive value (PPV) of NMFC was 89.33% and that of DO was 84.3% Negative predictive value (NPV) of NMFC was 93.33% and that of DO was 90.7%. Conclusion: NMFC is recommended tool for DR screening; but DO by well-trained optometrist can be reliable where neither ophthalmologist nor NMFC is available.

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Diagnostic accuracy of direct ophthalmoscopy for detection of diabetic retinopathy using fundus photographs as a reference standard

Cited by 11 publications

References 25 publications

Diagnostic Accuracy of Detecting Diabetic Retinopathy by Using Digital Fundus Photographs in the Peripheral Health Facilities of Bangladesh: Validation Study

Diagnostic Accuracy of Detecting Diabetic Retinopathy by Using Digital Fundus Photographs in the Peripheral Health Facilities of Bangladesh: Validation Study

Retrospective Evaluation of a Teleretinal Screening Program in Detecting Multiple Nondiabetic Eye Diseases

Diagnostic Accuracy of Direct Ophthalmoscopy and Non-Mydriatic Retinal Photography by Trained Optometrists for Screening of Diabetic Retinopathy

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